Against Medical Advice

Knowing when to trust your intuition and when to rely on medical wisdom is a delicate balance

My mother’s beautiful face is etched in my mind, creased by a soft pattern of a million tiny wrinkles. A signature of a life spent smiling, happy.

Aged 85, with short grey hair and a healthy complexion, she warms the hearts of everyone who knows her.

Although she often takes small steps when she walks, bending slightly forward to compensate for some back and hip pain while she gets up slowly from her chair, she usually radiates good health and humour.

So it was a surprise when I received a message from my father to say my mother was in the hospital.

‘What happened Dad?’ I asked as soon as I could free myself from the emergency unit at the children’s hospital where I worked.

He explained that the previous evening as my mother had walked from the living room towards the kitchen, her right foot hadn’t quite negotiated the doorstep and she’d fallen into the kitchen.

My father had rushed to help her and had managed to help her stand, though she couldn’t put any weight on her right foot. Dad had supported her and guided her to a chair where he examined the foot. Although it was exquisitely painful, my mother felt otherwise fine.

My father continued: ‘We phoned Dr. Jo and he came to the house and examined her a couple of hours after the fall. He was concerned about her mental state – he felt she was confused, not her usual self. Your mother was complaining of a numbness on her right side, so the doctor referred her to hospital, concerned she may have had a stroke…

‘Where are you now?’ I interrupted, with some urgency.

‘We’re in the emergency unit in the hospital next door to you. She’s been examined and they’ve decided she needs a brain scan, a bunch of lab tests and a 24-hour ECG. And she needs to go to the stroke unit tonight.’ My father sounded worried.

‘How is she now?’

‘Perfectly fine, although her right foot is still painful and swollen. Everything else has returned to normal.’

‘Don’t worry Dad, I’ll come over as soon as I get out of here,’ I reassured him, and hung up to attend another emergency. It was after 11pm when I finally left my ward.

When I arrived at the adult’s hospital next door, the porter wouldn’t let me in because visiting hours were over.

‘But she’s my mother!’

‘Sorry, sir. You’ll be able to see her after eight thirty tomorrow morning.’ The porter was not budging for anyone. I noticed my right hand had been squeezing my laptop bag just a bit too hard and was about to raise my voice when I realized how far apart we were. I lowered my eyes, struggled with my inner dispute and turned away, a big lump forming in my chest.

The next morning, I was on duty as usual long before visiting hours began, while the night porter was no doubt still resting at home. I called the unit for news about my mother and was relieved to hear her warm, clear voice.

‘How are you, Mum?’ I asked, tenderly.

‘I don’t know why I’m in hospital, Jan. My foot hurts, that’s all. Sorry, I need to hang up, the doctor’s here.’

‘No, wait, let me talk to him,’ I urged.

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The doctor kindly picked up my mother’s phone and in the following five minutes I learned that they had run tests and scans on her half the night.

As a result they’d put her on medication for high blood pressure, raised cholesterol, stomach acidity and pain.

They’d prescribed a blood thinner and she was now wearing a modern, light, but huge ankle splint. She was attached to a 12-lead ECG and an oxygen monitor, had a drip in her left hand and had been woken up every hour during the second half of the night for repeated neurological assessments.

The doctor reported that none of the scans showed she had suffered a stroke. He explained that she may possibly have an issue with amyloid, a specific protein in her blood vessels and iron deposits on the surface of her brain, which may have caused her symptoms and would require treatment with an antiepileptic drug on top of all the others. She’d also torn a ligament in her foot and a bit of bone had been ripped off with the tendon.

Translated to my world, I was grateful to hear that she hadn’t had a stroke, although she possibly had some ‘electric wiring’ issues and a tiny stable fracture in her right foot. The rest of it made absolutely no sense to me.

The doctor had planned to discharge her at 2pm but when I called my father at 6pm to find out how things were back at home, he replied, sounding exhausted: ‘We are still in hospital.’

I’d had enough and rushed to the hospital, determined to pick her up. As I expected, my mother was displaying no signs or symptoms of a stroke and was perfectly well. ‘Let’s get out of here,’ I urged.

‘No, we have to wait for the orthopedic surgeon’s opinion on the fracture. They need to determine whether they want to operate,’ my mother relayed to us.

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‘What?!’ I couldn’t hold back my frustration any longer. ‘You’re prepared to wait another 6 hours for an opinion on an x-ray?’ I glanced at the nurse, whose eyes told the whole story. She spoke quietly, ‘They’re still in theatre and will get out in about three hours.’

I whispered to my mother and father, ‘Just trust me on this, no one will operate on you tonight or even tomorrow. Let’s get out of here.’

Fifteen minutes later we left the hospital “against medical advice”. As my mother walked, the only thing causing her problems were the large immobilizing splint and the effects of all the drama and lost sleep of the night before. The new antihypertensive drugs were not helping either. My mother was an elderly woman who’d been suffering from low blood pressure for 50 years and now whenever she stood up she felt dizzy and faint.

We settled Mum at home and I changed her splint for a light ankle aircast, which meant she was pain-free and could walk easily without crutches. The long list of prescriptions went straight into the bin and I advised my mother to discuss the hospital’s recommendations with Dr Jo.

My father was curious. ‘Why did you feel so confident about leaving and not taking the drugs and changing the cast, Jan?’

I sighed. ‘Because I know the game, I’ve been in it for 20 years. I know how decisions are often made under stress in hospitals and I saw the signs that a large team of overwhelmed physicians were treating the disease and not the patient.

It’s a bit like that expression 'When you have a hammer, the world is full of nails!'

I explained further: ‘When there’s a drug you can prescribe for hypertension and the nurse tells you that a stroke patient has raised blood pressure while you are in ER sorting out a head trauma, what are you going to do? It’s a quick decision to issue instructions to start the medication and protect the brain from further damage. It makes perfect sense when you think of it in terms of pathology. It makes no sense at all when you know who you are treating.’

My father sat back in his chair. ‘I feel like we’ve just been put through a machine and have been spat out the other end!’ he said with feeling.

‘Hopefully your kids will be lucky enough to receive next-generation medicine where time is spent getting to know the patient and personal care regains its importance.’

That’s why Heart Based Medicine was created.

The story above is based on personal experiences. Places and names are fictional.